Use of and factors associated with self-treatment in China

Total expenditure elasticity of spending on self-treatment and professional healthcare: a case of Russia

The studies on the demand for healthcare in low- and middle-income countries rarely take into consideration the fact that many people spend their income on self-treatment and professional treatment. The estimation of the income elasticity of demand for self-treatment and professional treatment can show a more precise picture of the affordability of professional care. This paper contributes to the discussion around estimates of income elasticity of health spending and discussion whether professional care and self-treatment are close to a luxury good and inferior good respectively in a middle-income country. We apply the switching regression model to explain the choice between self-treatment and professional healthcare via estimates of the income elasticity. Estimates are made with the use of the Russian Longitudinal Monitoring Survey - Higher School of Economics (RLMS-HSE), a nationally representative survey. While individual expenditure on professional treatment is higher than that on self-treatment, our estimates show that expenses on professional treatment can be income inelastic except when spending on medicines prescribed by a physician that are elastic. The results also indicate that cost of self-treatment is income elastic. In all cases, the considered income elasticities are statistically insignificant between professional and self-treatment.

Prevalence and impacts of self-medication in a disadvantaged setting: the importance of multi-dimensional health interventions

Background

Self-medication is recognized as an effective form of treatment and is increasingly encouraged to treat minor illnesses. However, misuse of self-medication leaves devastating impacts on human health and causes antimicrobial resistance. Using medication without a prescription among farmers could cause more severe effects on their health than non-farm workers since they suffer from several occupational hazards such as excessive exposure to pesticides.

Methods

A cross-sectional study was conducted in 197 residents living in Moc Chau from August to September. A structured questionnaire and face-to-face were used to collecting data. The multivariate logistic model was applied to indicate associated factors with the self-medication.

Results

The prevalence of self-medication among farmers was 67%. Pain relievers (66.7%) and antibiotics (32.5%) were the types of medicines that were the most commonly purchased and used without a medical prescription. Ethnics and health status also significantly affected the self-medication practice as well as the purchase and use of antibiotics. The distance to travel to a medical center and the dangerous or difficult travel, participants with arthritis or inpatient treatment had significantly associated with buying and using the medicine and antibiotics without the medical prescription of farmers.

Conclusion

Our research highlights a considerably high prevalence of self-medication among farmers residing in the mountainous area of Vietnam. Individual factors such as ethnics, health status, distance to health centers, and dangerous or difficult travel were found to be related to the SM practice as well as the purchase and use of antibiotics. From that, the current study suggests interventions. For instance, official guidelines are needed to raise awareness and minimize the disadvantages of self-medication; and digital health technologies should be applied to reduce the gap in healthcare service between mountainous and other areas of Vietnam.

Association between multimorbidity patterns and healthcare costs among middle-aged and older adults in China

BACKGROUND

This study investigated multimorbidity patterns among middle-aged and older Chinese people and whether healthcare costs varied among different multimorbidity patterns.

METHODS

Data were from the 2011-2018 waves of the China Health and Retirement Longitudinal Study (CHARLS). We included 20,855 unique observations with information coming from their last wave of interviews and aged at least 45 years or older. Latent class analysis (LCA) was performed to classify individuals with common multimorbidity clusters based on 14 self-reported chronic diseases. Healthcare costs were from participants' self-reports and categorized into outpatient, inpatient, and self-treatment. Two-part regression was performed to analyze the association of multimorbidity patterns with healthcare costs.

RESULTS

Five multimorbidity clusters were identified: minimal disease, arthritis, cardiovascular disease (CVD), lung/asthma, and multisystem morbidity. The multisystem morbidity group had the highest use in all three types of healthcare and the highest self-treatment cost. Compared with the minimal disease group, the other four groups did not show significant differences in outpatient costs. Relative to the minimal disease group, the lung/asthma group reported lower inpatient costs.

CONCLUSION

Healthcare use and costs varied across multimorbidity patterns among middle-aged and older Chinese people. Implementing an integrated care plan for multimorbidity is suggested to improve the cost-effectiveness of healthcare provision and reduce the financial burden of the healthcare system. Reimbursement policy design should also take multimorbidity patterns into account.

Impacts of the hearing aid intervention on healthcare utilization and costs among middle-aged and older adults: results from a randomized controlled trial in rural China

BACKGROUND

Hearing impairment has become a major global health issue. To reduce the burden of hearing impairment, we explored impacts of the hearing aid intervention on healthcare utilization and costs.

METHODS

In this randomized controlled trial, participants aged 45+ were allocated with a ratio of 1:1.5 (intervention: control). Neither the investigators nor the assessors were blinded to the allocation status. Those in the intervention group were fitted with hearing aids, and those in the control group received no care. We applied the difference-in-difference (DID) approach to examine the impacts on healthcare utilization and costs. Given that social network and age can be significant variables affecting effectiveness of the intervention, subgroup analyses by social network and age were used to explore the heterogeneity.

FINDINGS

395 subjects were successfully recruited and randomized. 10 subjects did not meet the inclusion criteria and therefore, 385 eligible subjects (150 in the treatment group and 235 in the control group) were analyzed. The intervention significantly reduced their total healthcare costs (average treatment effect (ATE) = -1.26, 95% CI = -2.39, -0.14, p = 0.028) and total out-of-pocket (OOP) healthcare costs (ATE = -1.29, 95% CI = -2.37, -0.20, p = 0.021) in the 20-month follow-up. To be exact, it reduced self-medication costs (ATE = -0.82, 95% CI = -1.49, -0.15, p = 0.016) and OOP self-medication costs (ATE = -0.84, 95% CI = -1.46, -0.21, p = 0.009). Subgroup analysis showed that the impacts on self-medication costs and OOP self-medication costs varied by social network (ATE for self-medication costs = -0.26, 95% CI = -0.50, -0.01, p = 0.041; ATE for OOP self-medication costs = -0.27, 95% CI = -0.52, -0.01, p = 0.038). The impacts also varied by age groups (ATE for self-medication costs = -0.22, 95% CI = -0.40, -0.04, p = 0.019; ATE for OOP self-medication costs = -0.17, 95% CI = -0.29, -0.04, p = 0.010). There were no adverse events or side effects during the trial.

INTERPRETATION

Hearing aid use significantly lowered self-medication costs and total healthcare costs, but had no impacts on inpatient or outpatient services utilization or costs. The impacts were manifested among people with active social network or younger age. It can be speculated that the intervention may be adapted to other similar settings in developing countries to reduce healthcare costs.

FUNDING

P.H. reports grants from National Natural Science Foundation of China (No. 71874005) and Major Project of the National Social Science Fund of China (No. 21&ZD187).

TRIAL REGISTRATION

Chinese Clinical Trial Registry: ChiCTR1900024739.

Factors associated with the incidence and the expenditure of self-medication among middle-aged and older adults in China: A cross-sectional study

Background

With the accelerated ageing of population and the growing prevalence of various chronic diseases in China, self-medication plays an increasingly important role in complementing the health care system due to its convenience and economy.

Objective

This study aimed to investigate the incidence of self-medication and the amount of self-medication expenditure among middle-aged and older adults in China, and to explore factors associated with them.

Methods

A total of 10,841 respondents aged 45 years and older from the China Health and Retirement Longitudinal Study (CHARLS) wave 4 which conducted in 2018 were included as the sample of this study. The two-part model was adopted to identify the association between the incidence of self-medication and the amount of self-medication expenditure and specific factors, respectively.

Results

The incidence of self-medication among Chinese middle-aged and older adults was 62.30%, and the average total and out-of-pocket (OOP) pharmaceutical expenditure of self-medication of the self-medicated individuals were 290.50 and 264.38 Chinese yuan (CNY) respectively. Participants who took traditional Chinese medicine (TCM), self-reported fair, and poor health status, suffered from one and multiple chronic diseases had strongly higher incidence of self-medication. Older age and multiple chronic diseases were strongly associated with higher expenditure of self-medication. Those who took TCM had more self-medication expenditure, while those who drank alcohol had less.

Conclusion

Our study demonstrated the great prevalence of self-medication among middle-aged and older adults in China and the large pharmaceutical expenditure that come with it, especially in the high-risk groups of self-medication identified in this paper. These findings enhanced our understanding of self-medication behaviors among Chinese middle-aged and older adults and may contribute to the formulation of targeted public health policy.

Patterns and Determinants of Antibiotic Use Behaviors among Rural Community Residents in Eastern China

Inappropriate antibiotic use may lead to antibiotic resistance, which has become a serious global crisis. Addressing suboptimal antibiotic use in the general population can play a significant role in the fight against antimicrobial resistance. This study aims to describe antibiotic use and sources of acquisition, and to identify factors influencing antibiotic access among rural community residents in Eastern China. A cross-sectional survey was conducted from July to August 2020, and 1494 participants from two villages in Eastern China were enrolled. Information was obtained using face-to-face interviews with a structured electronic questionnaire. Chi-squared and multinominal logistic regression analysis were used to explore possible determinants. In total, 1379 participants were eligible for the analysis. In the past 12 months, nearly half the respondents had taken any antibiotic (48.4%), and this proportion varied across marital status and age group. Two thirds of them (59.9%) obtained antibiotics from medical facilities with a prescription when they last took antibiotics, while 17.7% and 22.4% chose retail pharmacies and other sources, respectively. Multinominal analysis found that a higher proportion obtained antibiotics outside medical facilities among those aged 15 to 44 years, unmarried, non-white collar workers, with more years of education, lower annual household income per capita and lower levels of antibiotic knowledge. The antibiotic use behavior of rural community residents in Eastern China remains suboptimal. Antibiotic use and access behaviors need to be further addressed. Effective antibiotic stewardship in non-medical facility sources and training programs targeted for rural Chinese is warranted in future.

The impact of current smoking, regular drinking, and physical inactivity on health care-seeking behavior in China

Background

People with lifestyle behaviors, such as current smoking, regular drinking, and physical inactivity, may experience a lack of or delayed health care, leading to severe sickness and higher health care expenditures in the future. Hence, the current study aims to ascertain the effects of current smoking, regular drinking, and physical inactivity on health care-seeking behavior among adults who report physical discomfort in China.

Methods

The data used in this study were obtained from the China Family Panel Studies (CFPS). The final sample consisted of 44,362 individuals who participated in all five waves of data collection. Logistic regression models were used for the analysis.

Results

The results of fixed effects logistic regression showed that among those who reported physical discomfort, adults who currently smoked cigarettes were 0.65 times less likely to seek health care than those who formerly smoked. Compared to nondrinkers, adults who regularly drank alcohol had a decreased likelihood of seeking health care. Adults who never engaged in physical exercise had 24% lower odds of seeking health care than those who engaged in physical exercise.

Conclusions

Current smoking, regular drinking, and physical inactivity decreased the probability of seeking health care among adults who reported physical discomfort. Therefore, screening and brief advice programs should be delivered by primary-level care and should pay more attention to individuals who engage in lifestyle behaviors such as current smoking, regular drinking, and physical inactivity, thus avoiding missed opportunities to treat chronic conditions and detect new diseases early.

Non-prescriptionxx antibiotic use for people aged 15 years or older for cough in China: a community-based survey

BACKGROUND

Non-prescription antibiotic use at community is a main driver of antimicrobial resistance. Cough is a common condition and prevalent in all townships, including China. This study aims to investigate the non-prescription antibiotic use for cough in China and explore to which extent antibiotic use knowledge was correctly instructed in communities.

METHODS

A probability-proportionate-to-size sampling method was adopted to survey from all 14 townships in Yiwu city, China. All participants were investigated by face-to-face interview on Portable Android Devices. The continuous variables were presented by mean and standard deviation or medium and inter-quartile range (IQR). The categorical variables were presented using percentage or constituent ratio. Chi-square test for univariate analysis and logistic regression for multivariate analysis were conducted to assess the odds ratios and 95% confidence intervals, respectively.

RESULTS

A total of 3034 respondents across all the 14 townships and the 50 natural villages/streets completed all key items of the questionnaire. Of 2400 (79.10%) respondents stated that they experienced cough in the past 12 months with the medium age of 36.5 (IQR: 26-49) and 12.21% (293/2400) respondents had the non-prescription antibiotic use behavior. Among those 293 respondents, the proportion of non-prescription antibiotic use for cough peaked at around 16% among people aged 30-39 years old. The major sources of antibiotics were pharmacy (77.70%) and/or family storage (43.92%).

CONCLUSIONS

Non-prescription antibiotics use for cough is prevalent in the community, especially among people in their thirties. Strengthened drug purchase regulation and well-trained professional pharmacists would be promising alternatives to ameliorate AMR. Moreover, penetrating antibiotics knowledge to common citizens and is an urgent task to alleviate antimicrobial resistance. Therefore, proactive policies and regulations should be made to improve current situations.

Prevalence and Associated Factors of Self-Treatment among the Elderly-A Comparative Study between Empty and Non-Empty Nesters in Shandong, China

(1) Objectives: With an aging society in China, self-treatment now plays an important role in health care among older adults, but it can be problematic. This study aims to explore and compare the self-treatment behavior among empty and non-empty nesters. (2) Methods: Using a multi-stage stratified random cluster sampling method, a total of 4366 elderly people aged 60 and above from Shandong Province, China, were enrolled in this study. Data were collected through a structured questionnaire. Binary logistic regression was used to analyze the associated factors of self-treatment. (3) Results: The prevalence of self-treatment in empty nesters was significantly lower than that in non-empty ones (74.0% vs. 83.3%). Binary logistic regression analysis showed that higher educational level and poorer self-rated economic status were negatively associated with self-treatment in empty nesters, while unemployed and urban and rural residents' basic medical insurance were positively associated with self-treatment in non-empty ones. (4) Conclusions: The study indicated that empty nesters had lower likelihood of self-treatment than non-empty ones. Empty nesters with better socioeconomic status were more likely to use self-treatment; by contrast, non-empty nesters with relatively poorer socioeconomic status were more inclined to self-treatment. Targeted interventions should be developed to maximize the effectiveness of self-treatment and reduce health risks.

Gender difference in the association of frailty and health care utilization among Chinese older adults: results from a population-based study

BACKGROUND

Frailty is a public health concern in the ageing population. Little is known about the role of gender in the relationship between frailty and health care utilization in older adults.

AIMS

The study aims to examine gender differences in the association between different frailty status and health care utilization among Chinese older people.

METHODS

A total of 7070 older adults (60+) from Shandong Province, China, were enrolled in this study. Frailty was assessed by frailty index constructed using 45 health deficits. Multivariate logistic regression models were employed separately for men and women to examine the impact of frailty on self-care, outpatient, and inpatient utilization.

RESULTS

Overall, the prevalence of frailty was 7.9% in older adults, with 7.1% and 8.3% in men and women, respectively. 49.4% respondents reported they had self-care in the previous 2 weeks, and women were more likely to have self-care than men. Being pre-frail and frail was significantly associated with utilization of all types of health care among older men and women, and the relationship was stronger in the frail groups than that in the pre-frail groups except for self-care. Respective odds ratios for outpatient utilization were higher in men than that in women.

CONCLUSIONS

Frailty is a frequent condition in Chinese older adults. The association between frailty and health care utilization (except outpatient) tended to be stronger in women than men. The gender differences should be considered when designing the preventing or delaying the installation of frailty and geriatric care plans.

Self-care for anxiety and depression: a comparison of evidence from Cochrane reviews and practice to inform decision-making and priority-setting

BACKGROUND

Self-care refers to a range of activities and approaches undertaken by an individual to maintain health and manage ill-health which may include various complementary or alternative approaches. The purpose of this study was to identify the self-care approaches used by the general public for depression and anxiety, assess the usefulness of Cochrane reviews for informing decisions on self-care and highlight any gaps in the evidence.

METHODS

Searches were carried out for surveys of self-care for anxiety and/or depression and for Cochrane reviews and protocols of interventions with potential for use in self-care. Data was extracted from each review and Plain Language Summaries assessed for content, consistency and readability. Interventions reported in surveys and in Cochrane reviews were compared and effectiveness of each assessed.

RESULTS

Surveys from 10 countries reported a variety of self-care interventions, 17 of which appeared in 2 or more surveys and which included dietary supplements, herbal medicines, mind-body therapies and various forms of exercise. Twenty-two reviews and 5 protocols on potential self-care interventions were identified, the majority in depression. Twelve interventions were judged effective or promising, most with small effect sizes. Readability of summaries was highly variable: half were written at college/university level. Several commonly used approaches were not covered by Cochrane reviews.

CONCLUSIONS

This study has revealed the interventions currently used by the general public which are judged effective or promising based on Cochrane reviews. Some disparity is highlighted between interventions used in practice and the availability of reliable evidence, and in the presentation of effectiveness and safety. Being able to direct patients to reliable, accessible information is a positive step in ensuring effective patient-centered, evidence-informed care. Addressing gaps, ensuring consistency and increasing usability of evidence intended for the general public will support this goal.

Socioeconomic Inequality in Self-Medication in Iran: Cross-Sectional Analyses at the National and Subnational Levels

Background

Self-medication (SM) is a public health concern globally. This study aimed to measure socioeconomic inequality in SM and identify its main determinants among Iranian households.

Methods

A total of 38,859 households from the 2018 Household Income and Expenditure Survey (HIES) were included in the study. Data on SM, household size, age, gender and education status of the head of household, monthly household’s expenditures (as a proxy for socioeconomic status), health insurance coverage and living areas and provinces were obtained for the survey. The concentration curve and the normalized concentration index (C_n) were used to quantify the magnitude of socioeconomic inequality in SM among Iranian households. The C_n was decomposed to identify the main determinants of socioeconomic inequality in SM in Iran.

Results

The results indicated that 18.2% (95% confidence interval [CI]: 17.7% to 18.5%) of households in Iran had SM practice in the past month. The results suggested a higher concentration of SM among the rich households (C_n= 0.0466; 95% CI= 0.0321 to 0.0612) in Iran. The concentration of SM among high SES households was also found in urban (0.0311; 95% CI=0.0112 to 0.0510) and rural (= 0.0513; 95% CI=0.0301 to 0.0726) areas. SM was concentrated among the rich households in Tehran, Qom, Esfahan, Ardebil, Golestan, and Sistan and Baluchestan provinces. In contrast, a higher concentration of SM was found among the poor households in Semnan, North Khorasan, Kerman, Bushehr, and South Khorasan provinces. The decomposition revealed SES of household, itself, as the main contributing factor to the concentration of SM among the wealthy households.

Conclusion

This study demonstrated that SM is more concentrated among socioeconomically advantaged households in Iran. Thus, effective evidence-based interventions should be implemented to improve awareness about SM and its negative consequences. Further studies are required to investigate the consequences of SM practice among people.

The impact of hospital attributes on patient choice for first visit: evidence from a discrete choice experiment in Shanghai, China

The underutilization of primary care in urban China threatens the efficiency and effectiveness of the Chinese health system. To guide patient flow to primary care, the Chinese government has rolled out a sequence of health care reforms which improve the affordability, the infrastructure and workforce of the primary care system. However, these measures have not yielded the desired effect on the utilization of primary care, which is lowest in urban areas. It is unclear how the factors identified to influence facility choice in urban China are actually impacting choice behaviour. We conducted a discrete choice experiment to elicit the quantitative impact of facility attributes when choosing a health care facility for first visit and analysed how the stated choice varies with these attributes. We found that the respondents placed different weights on the identified attributes, depending on whether they perceived their condition to be minor or severe. For conditions perceived as minor, the respondents valued visit time, equipment and medical skill most. For conditions perceived as severe, they placed most importance on equipment, travel time and facility size. We found that for conditions perceived as minor, only 14% preferred visiting a facility over opting out, a percentage which would more than double to 37% if community health centres were maximally improved. For conditions perceived as severe, improvements in community health centres may almost double first visits to primary care, mostly from patients who would otherwise choose higher-level facilities. Our findings suggest that for both severity conditions, improvements to medical equipment and medical skill at community health centres in urban China can effectively direct patient flow to primary care and promote the efficiency and effectiveness of the urban health system.

Prevalence and associated factors of self-treatment behaviour among different elder subgroups in rural China: a cross-sectional study

Background

Self-treatment is a common and widespread behaviour, of which the risks are multiplied in old age. However, the determinants of self-treatment among elders in rural China remain unclear. This study aims to explore the prevalence and associated factors of self-treatment among elders in rural China, trying to discover the vulnerable groups as well as the service gaps among the rural elders.

Methods

Based on a multi-stage stratified random sampling method, a cross-sectional household survey was conducted among 30 villages in Sinan County, an impoverished county in western China. Data were collected through a household–individual combined questionnaires. The analysis was restricted to elders who reported illness within the last 2 weeks, and the final sample size was 330 (individuals). Bivariate and multiple logistic regression analysis were performed in the whole sample group and four subgroups to obtain the prevalence ratios regarding the associated factors.

Results

In the present study, 35.2% of the elders with illness within the last 2 weeks reported self-treatment. The variables associated with self-treatment in the whole sample group were health status (OR 6.75, 95%CI 1.93–23.60), recent alcohol consumption (OR 0.42, 95%CI 0.21–0.83) and the utilisation of family practice services (OR 0.59, 95%CI 0.36–0.96); the same predictors were found in the subgroup of elders with chronic diseases. No significant predictors were found in the subgroup of elders without chronic diseases. Empty-nest elders with higher affinity to traditional Chinese medicine (OR 0.39, 95%CI 0.18–0.86) or drinking alcohol recently (OR 0.28, 95%CI 0.09–0.82) were less likely to self-treat, while the non-empty-nest elders who were no less than 75 years old (OR 3.10, 95%CI 1.33, 7.22) or at better health status (OR 9.20, 95%CI 1.73–48.75) were more likely to self-treat.

Conclusion

Self-treatment was prevalent among the elders in rural China. Better health status, no recent alcohol consumption and no utilisation of family practice are associated with self-treatment among rural elders. Older elders in the non-empty nest group were more likely to self-treat, while the empty-nest elders with self-care habits in traditional Chinese medicine were less likely to self-treat. Deeper understanding of the self-treatment behaviour among rural elders may provide insights for identifying the potential service gaps and developing improvement strategies in the health care delivery system for the elderly in China.

Self-medication and knowledge among pregnant women attending primary healthcare services in Malang, Indonesia: a cross-sectional study

BACKGROUND

Self-medication with over-the-counter (OTC) drugs is an important public health concern, especially in the vulnerable population of pregnant women due to potential risks to both the mother and fetus. Few studies have studied how factors, such as knowledge, affect self-medication. This study investigated self-medication and its associated factors among pregnant women attending healthcare services in Malang, Indonesia.

METHODS

A cross-sectional study was conducted from July to September 2018 in five healthcare services. A self-administered questionnaire was used and the data were analyzed using multiple regression models.

RESULTS

Of 333 female participants, 39 (11.7%) used OTC medication. Women with a higher level of knowledge of OTC medication were more likely to self-medicate-adjusted odds ratio (aOR) = 2.15, 95% confidence interval (CI) = 1.03-4.46. Compared with those with less knowledge, pregnant women with more correct knowledge of the possible risk of self-medication were less likely to self-medicate-aOR = 0.29; 95% CI = 0.14-0.60. The effect of a higher level of knowledge of OTC medication was significant among women who had middle school and lower education-aOR = 8.18; 95% CI = 1.70-39.35. The effect of correct knowledge on the possible risks of self-medication was significant only among women with high school and higher education-aOR = 0.17; 95% CI = 0.07-0.42.

CONCLUSION

Imparting specific knowledge of the potential risks of using non-prescribed medication during pregnancy may help pregnant women navigate and more safely manage their OTC use. We also suggest further collecting data from more healthcare services, such as hospitals, to obtain more findings generalizable to the Indonesian community.

Concordance of chronic conditions among the household members in Shanghai: a cross-sectional study

OBJECTIVES

Members living in the same household tend to share some similar behaviours and environment. We want to quantitatively assess the associations of chronic conditions to investigate the concordance of disease status among the household members.

SETTING

Shanghai, China.

PARTICIPANTS

Our data were from the fifth Health Service Survey in Shanghai in 2013. 12 002 households with 31 531 residents were selected in this survey by using a three-stage, stratified, random sampling method.

OUTCOME MEASURES

Five highly prevalent chronic conditions, namely hypertension, diabetes, ischaemic heart disease (IHD), cerebrovascular disease (CVD) and obesity were chosen. The generalised estimating equations (GEE) model was used to estimate the associations adjusted for age, gender, education status, health insurance status, smoking and drinking. Using a subsample of adult children with parents' chronic conditions as the key risk factor and a subsample of wives with the chronic conditions of the husband as key risk factor, we reran our GEE models to explore chronic condition concordance within these relationships.

RESULTS

A total of 10 198 households with 27 010 adult participants were included. Using all adult household members, we found positive statistically significant associations between one's chronic conditions and the same disease status of their household members (hypertension (OR=3.26, 95% CI 3.02 to 3.52); diabetes (OR=1.68, 95% CI 1.40 to 2.01); IHD (OR=5.31, 95% CI 3.56 to 7.92); CVD (OR=3.40, 95% CI 1.99 to 5.80); obesity (OR=3.41, 95% CI 2.34 to 4.96)). The results of analysing ad-child subsample and spouse subsample also showed similar associations. Moreover, the potential concordance of different chronic conditions was found between hypertension and diabetes.

CONCLUSIONS

We found chronic condition concordance within households. This study provides evidence that the chronic conditions of other members of a household may be a significant risk factor for a household member's own health.

Inequities in Access: The Impact of a Segmented Health Insurance System on Physician Visits and Hospital Admissions Among Older Adults in the 2014 China Family Panel Studies

The fragmentation of job-based and community-based insurance plans inevitably undermines health care accessibility in China’s market-oriented health system, especially for uninsured and rural residents. Based on the 2014 China Family Panel Studies, this secondary data analysis examined whether socioeconomic indicators, health-related determinants, and particularly social health insurance status affect physician visits in the past 2 weeks and hospital admissions in the past 12 months among a representative sample of older adults (n = 6,570). Grounded in Andersen’s behavioral framework, 2 series of logistic regression analyses were performed: one was built in a hierarchical manner, assessing blocks of predisposing, enabling, health-need, and lifestyle-behavioral factors; the other was conducted in a cross-referencing manner, comparing uninsured populations with job-based and community-based insurance enrollees. Results show that, after full adjustment, the odds of physician visits were lower among urban insurance enrollees (OR = 0.67, 95% CI: 0.47–0.97) than rural residents. For hospital admissions, both uninsured elders (OR = 0.65, 95% CI: 0.48–0.87) and community-based insurance enrollees (OR = 0.67, 95% CI: 0.47–0.97) had lower use of inpatient care than job-based insurance enrollees, demonstrating inequitable access. This study suggests that policy efforts should unify the social health insurance system to combat existing insurance-related inequities in health care use for underserved aging populations.

Self-medication practices among Vietnamese residents in highland provinces

Background: Monitoring self-medication practice, which refers to individuals using medicine without instructions of physicians, is critical to control its harmful effects. However, in Vietnam, evidence about self-medication among individuals in highland areas is constrained. This study examined self-medication practice among residents living in highland areas in Vietnam and determined associated factors. Materials and methods: A cross-sectional study was performed in five highland provinces with 1000 individuals. Information about individual and household's socioeconomic status and self-medication practice in the last 12 months was surveyed. Multivariate logistic and Poisson regressions were used to identify associated factors with self-medication. Results: 83.3% reported self-medication in the last 12 months, with the mean times of self-medication being 4.5 times (SD=4.1). Female (OR=0.62, p<0.01), ethnic minorities, higher number of members having health insurance in family (OR=0.82, p<0.01) and higher annual household income (OR=0.78, p<0.05) were associated with the lower likelihood of "Only buy medicines at pharmacy stores when having illness in the last 12 month". Moreover, people who were females (OR=0.59, p<0.05), white-collar worker (OR=0.25, p<0.01) and had higher number of children in the family (OR=0.68, p<0.05) were less likely to practice self-medication. People who were ethnic minorities, white-collar worker (Coef.=-0.32, p<0.01) and higher number of members having health insurance in family had lower times of self-medication in the last 12 months compared to other groups. Meanwhile, individuals having higher number of members in the family (Coef.=0.07, p<0.01) and higher annual household income (Coef.=0.08, p<0.01) had highertimes of self-medication in the last 12 months. Conclusion: Residents in highland areas in Vietnam had a considerably high 12-month prevalence of self-medication. Medical products quality management and self-medication guideline are potential to maximize the effects of self-medication. Moreover, promoting the use of health insurance should also be concerned as a solution to address this issue.

Self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia

Background

Self-medication is the use of any drug or medication to treat an illness or ailment without the supervision of a licensed medical doctor/health care providers. Self-medication practice in Eastern Ethiopia is quite common. However, there is little information with regard to magnitude and associated factors. The objective of this study was to assess the magnitude of self-medication practice and associated factors among adult community members of Jigjiga town, Eastern Ethiopia.

Methods

A community based cross-sectional study was conducted from June 27- July 12, 2017. Multistage sampling method was used and the number of kebeles and Sub-kebeles were selected using simple random sampling technique. Finally, sampled households in the Sub-kebeles were selected using systematic random sampling. Data were collected using face to face interview with 547 adult (≥18 years) participants. It was entered and cleaned using EPI-Data version 3.02 and exported to Statistical Package for Social Science (SPSS) Version 23 for further analysis. Bi-variable and multivariable logistic regression models were carried out to identify factors associated with the self-medication.

Result

The magnitude of self-medication was found to be 37.5% (95% CI: (33.6%–41.7%). Educational status of secondary school [(AOR = 0.46; 95% CI: (0.22–0.98)], high income [(AOR = 3.00; 95% CI: (1.77–5.06)], advised by neighbors, friends or relatives to take drug for their complaint [(AOR = 2.59; 95% CI: (1.62–4.14)], used old prescription /past experience to bought drugs [(AOR = 12.19; 95% CI: (6.65–22.35)], follow advertisements of drugs by television [(AOR = 0.21; 95% CI: (0.05–0.85)], and perception about Hospital drugs (clinics, health centers and hospitals) do not work [(AOR = 2.36; 95% CI: (1.39–3.99)] were significantly associated with self-medication.

Conclusion

High income, advice by neighbors, friends or relatives to take drug for their complaint, old prescription/past experience use to bought drugs, and perception of hospital drugs do not work was positively associated with self-medication. Therefore, health education should be given to the community on the importance of hospital drugs (clinics, health centers and hospitals) to shift their perception.

Consumers' Perceptions About Pharmaceutical Care Provided by Community Pharmacists in China in Relation to Over-the-Counter Drugs: A Qualitative Study

While patient-centered care is highly anticipated nowadays, investigation of consumers’ perceptions and expectations about pharmacist’s pharmaceutical care when providing over-the-counter (OTC) drugs is sparse. This article aimed to explore consumers’ perceptions regarding the pharmaceutical care that community pharmacists provide in relation to OTC drugs. Semistructured interviews were conducted with consumers recruited (N = 97) in Yinchuan City, China. The 4 main themes that emerged were expectations on pharmaceutical care, attitude toward pharmacist’s competence, experience of self-medication, and suggestions for improving pharmaceutical care. Most participants had high expectations on community pharmacists to recommend the right medicines, to advise them about the effective use of drug, to advise them about the safe use of drug, and to recommend economic drugs. However, their previous experiences at community pharmacy were far from satisfaction reportedly, leading to a general distrust in pharmacist’s certification and qualification, knowledge, communication skills, and attitude. As a result, the participants turned to self-medication based on their personal experiences, their relatives’ experiences, the information on drug label, and the information distributed in the mass media. Realizing the need to improve pharmaceutical care, the participants also made improvement suggestions specific to community pharmacist, community pharmacy, and the government.

Prevalence and Reasons of Self-Medication in Pregnant Women: A Systematic Review and Meta-Analysis

BACKGROUND

Given the importance of having valid information about the prevalence and reasons of self-medication among pregnant women for preventing self-medication during this period, this study aimed to systematically review and perform a meta-analysis on the prevalence and reasons of self-medication during pregnancy.

METHODS

This systematic review and meta-analysis was conducted in 2018 to estimate the overall self-medication prevalence based on the database sources PubMed, Scopus, Google Scholar, MagIran, IranMedex and SID. Required data were collected using keywords: medication, self-medication, over-the-counter, non-prescription, prevalence, etiology, and occurrence and pregnant. Descriptive and cross-sectional studies in English and Persian languages were included. There was no time limitation for search. R software was applied for meta-analysis. Random-effects model was applied to estimate the self-medication prevalence with 95% confidence interval. Q statistics and I2 were used to measure the heterogeneity.

RESULTS

Out of 490 retrieved articles, finally 13 studies were included in meta-analysis, 6 studies of which reported the cause of self-medication. The overall estimated prevalence of self-medication based on the random effect model was 32% (95% CI, 22% - 44%). The most important reasons of self-medication were previous experience of the disease. The most important group of disease in which patients self-medicated was anemia. Also, the most important group of medication was herbal.

CONCLUSION

The results of this study showed that the prevalence of self-medication among pregnant women was relatively high and required effective interventions to reduce and prevent self-medication among this group. Providing required information and raising awareness about complications resulting from self-medication, in particular herbal medicines and dietary supplements, should be taken into account.

Why patients prefer high-level healthcare facilities: a qualitative study using focus groups in rural and urban China

INTRODUCTION

Despite policy measure to strengthen and promote primary care, Chinese patients increasingly choose to access higher level hospitals. The resulting overcrowding at higher level hospitals and underutilisation of primary care are viewed to diminish the effects of the continuing health system investments on population health. We explore the factors that influence the choice of healthcare facility level in rural and urban China and aim to reveal the underlying choice processes.

METHODS

We conducted eight semistructured focus group discussions among the general population and the chronically ill in a rural area in Chongqing and an urban area in Shanghai. Respondents' discussions of (evidence-based) factors and how they influenced their facility choices were analysed using qualitative analysis techniques, from which we elicited choice process maps to capture the partial order in which the factors were considered in the choice process.

RESULTS

The factors considered, after initial illness perception, varied over four stages of health service utilisation: initial visit, diagnosis, treatment and treatment continuation. The factors considered per stage differed considerably between the rural and urban respondents, but less so between the general population and the chronically ill. Moreover, the rural respondents considered the township health centres as default and prefer to continue in primary care, yet access higher levels when necessary. Urban respondents chose higher levels by default and seldom moved down to primary care.

CONCLUSIONS

Disease severity, medical staff, transportation convenience, equipment and drug availability played important roles when choosing healthcare facilities in China. Strengthening primary care correspondingly may well be effective to increase primary care utilisation by the rural population but insufficient for the urban population. The developed four-stage process maps are general enough to serve as the basis for (partially) ordering factors influencing facility level choices in other contexts.

Impact of hypertension on health-related quality of life among different age subgroups in Shanghai: the subpopulation treatment effect pattern plot analysis

The aim of our study was to investigate the effect of hypertension on health-related quality of life (HRQoL) among different age subgroups of people in Shanghai using subpopulation treatment effect pattern plot (STEPP) methodology. We utilized data from the fifth Health Service Survey of Shanghai, 2013, which utilizes a cross-sectional study design. The participants were selected into the survey by using a three-stage, stratified, random sampling method. HRQoL was evaluated by the EuroQol five-dimensional 3 level (EQ-5D-3L) questionnaire, and the EuroQol-visual analog scales (EQ-VAS) score was the main outcome. A generalized estimating equations (GEE) model adjusted for socio-demographic covariates was used to determine the effect of hypertension on HRQoL. STEPP analysis was performed to explore the effect of hypertension within overlapping age subpopulations. Subgroup analyses for gender were conducted for the main outcome. A total of 28,730 residents who were 18 years or older were included in our study. The results of the multivariate GEE model showed that hypertension negatively affected HRQoL in the study population (estimate = -1.85, p < 0.0001). According to the STEPP analysis, we found that the EQ-VAS score in the hypertension group was lower than that in non-hypertension group for every age group. Additionally, the results of subgroup analyses indicated that the difference of score between two groups was larger among young women. When compared to respondents without hypertension, respondents with hypertension experienced lower HRQoL regardless of gender or any range of age. Furthermore, the impact of hypertension on HRQoL of young women might be more obvious.

Descriptions of self-treatment for the middle-aged and elderly in Shanxi, China

OBJECTIVES

Self-treatment is a widespread practice among patients with common symptoms and ailments; it is necessary to explore multiple aspects of it. Notably, there is little research into self-treatment among middle-aged and elderly people, who are more likely to fall ill. Our goals are to provide a comprehensive description of self-treatment and explore associated factors with insurance utilization and expenditures among the middle-aged and elderly populations in China.

METHODS

A survey was conducted in July 2016 in Shanxi, China. A stratified sampling scheme was applied to achieve representativeness. A total of 972 subjects were surveyed. Descriptive statistics, t- and Chi-squared tests, multivariate logistic regression, and multivariate linear regression were utilized.

RESULTS

In our study, 772 (79.4%) of the surveyed subjects self-treated during the previous twelve months. Among them, 253 (32.8%) used health insurance. Subjects' characteristics were associated with insurance utilization and expenditures for self-treatment. Total cost was positively associated with insurance utilization. The subjects with a junior high education (p-value < 0.001, aOR = 0.049) and senior high education (p-value = 0.020, aOR = 0.146) had a lower probability of using insurance. For both total costs and out-of-pocket costs, subjects who were 51 to 60 years old had lower costs. The subjects who were seriously sick and had a primary school education, as well as enterprise occupations, had higher costs. Self-treatment times were also positively associated with costs. Finally, it was found that subjects who didn't use insurance had lower total costs.

CONCLUSIONS

The prevalence of self-treatment was high (79.4%). Some characteristics were associated with insurance utilization and expenditures in self-treatment. Our results may be helpful for policy interventions, which are needed to further improve the effectiveness of health insurance in China.

Urban-rural disparities in health care utilization among Chinese adults from 1993 to 2011

BACKGROUND

Despite economic growth and improved health outcomes over the past few decades, China still experiences striking urban-rural health inequalities. Urban and rural residents distinguished by the hukou system may experience profound disparities because of institutional effect. The aim of this study is to estimate trends in urban-rural disparities in self-care, outpatient care, and inpatient care utilization from a perspective of the hukou system.

METHODS

Data were extracted from the seven latest waves of the China Health and Nutrition Survey (CHNS). We used the hukou system to distinguish between urban and rural residents. Chi-square tests were performed to examine urban-rural gaps in self-care, outpatient care, and inpatient care utilization. Multinomial logistic regression was employed to confirm these disparities and to explore whether the urban-rural gaps have narrowed or widened from 1993 to 2011 once known determinants of utilization are taken into account according to Andersen/Aday's Health Behaviour Model.

RESULTS

The urban-rural disparities were evident after controlling for confounding variables: urban adults were 3.24 (p < 0.05), 2.23 (p < 0.1), and 4.77 (p < 0.01) times more likely to choose self-care vs. no care, outpatient care vs. no care, and inpatient care vs. no care than their rural counterparts, respectively. The results showed upward trends in self-care, outpatient care, and inpatient care utilization from 2004 to 2011. The urban-rural gaps in health care utilization gradually narrowed during the period of 1993-2011. The hukou distinctions of self-care, outpatient care, and inpatient care in 2011 were only 33.3%, 35.5%, and 9.6% of that in 1993, respectively.

CONCLUSIONS

Although rural residents were underutilizing health care when compared to their urban counterparts, the significant decrements in urban-rural disparities reflect the positive effect of the on-going health system reform in China. To maintain an equitable distribution of health care utilization, policy makers need to be aware of challenges due to aging problems and health expenditure increment.

Sociodemographic Characteristics Of The Over-The-Counter Drug Users In Serbia

Background:

The analysis of socio-demographic factors on the use of over-the-counter drugs for self-medication and over the counter drugs such as vitamins and minerals for boosting the immune system.

Objective:

The objective is to look into socio-demographic factors of the interviewees who use Over-the-Counter drugs.

Methods:

Data obtained through the results of the National health survey of the Republic of Serbia 2013. Dependent variable was transformed such a way that vitamins and herbal medicaments for strengthening the body were merged into one group preparations for boosting the immune system and drugs for self-treatment into the group preparations for self-medication.

Results:

The interviewees more often use OTC for boosting the immune system rather that OTC for self-medication. Women and highly educated people use OTC preparations more often. Unemployed people coming from rural areas use OTC preparations less often. People who have primary education buy OTC products for boosting the immune system significantly more often in comparison to highly educated people (OR = 3.95), but they use OTC drugs for self-medication less frequently (OR = 0.25). The poorest interviewees buy OTC drugs for self-medication twice times less often than the rich, respectively, but they buy OTC vitamins and other immunoregulators 1.4 times more often than the rich, respectively.

Conclusion:

Highly educated, rich and people coming from developed regions very often buy OTC drugs for self-medication, while poor, less educated people coming from undeveloped regions more often buy OTC preparations for boosting the immune system.

Self-Medication Practice and Associated Factors among Residents in Wuhan, China

Background: This study aims to examine the prevalence and predictors associated with self-medication, and related consequences in Wuhan, China. Methods: Two-hundred-sixty residents were interviewed from randomly selected four districts of Wuhan, China. A modified version of Anderson’s health behavioral model was used in the survey to collect information of self-medication behavior. Multivariable logistic regression analyses were used to measure correlates of the prevalence of self-medication. Results: Nearly half of the respondents would select self-medication, and 39.1% would see a doctor if they felt sick. The most common self-medicated illnesses were cold and cough, cardiovascular disease and gastrointestinal disease. The main reasons for self-medication were that the illness was not severe (enough) to see the doctor (45%); the patient did not think that the trouble of seeing a doctor was worth the effort (23%); the patient had no time to see the doctor (12%), and the patient did not want to pay high medical costs (15%). Logistic regression results suggested that respondents tended to select self-medication if the illness was minor or short-term (less than seven days). Conclusions: Our findings suggest that more strict regulation on over-the-counter medicines may be required to reduce health risks related to self-medication. Targeted health education on the risks of self-medication should be considered.

Socioeconomic differences in self-medication among middle-aged and older people: data from the China health and retirement longitudinal study

OBJECTIVES

Self-medication with over-the-counter medicines (OTCs) and prescription-only medicines (POMs) are both pervasive in China, although the latter is an inappropriate practice. We examined the relationship between socioeconomic status (SES) and self-medication with OTCs versus POMs.

METHODS

Multivariate logistic regressions based on the Andersen framework were estimated using a subsample of respondents aged 45 years and over from the China Health and Retirement Longitudinal Study collected between 2011 and 2013 (n=23 699). As dependent variables, we used OTC and POM consumption without a medical prescription. SES was operationalised by household income per capita and education. Control variables included health indicators, demographic characteristics, and health behaviours.

RESULTS

In our study sample, 32.69% and 15.02% of people aged 45 years and over had self-medicated with OTCs and POMs in the 4 weeks before the survey, respectively. OTC use by income exhibited an inverse U shape. Respondents from middle income groups were more likely to self-medicate with OTCs compared with those from the lowest and highest income groups. In contrast, respondents from the lowest income group were more inclined to self-medicate with POMs. There was a clear trend towards more self-medication with OTCs, but not POMs, among those with higher educational attainment.

CONCLUSION

People with low income tended to rely on self-medication with POMs for treatment, which is risky and of low quality. A health education programme for older people, particularly those living in low-income households, aimed at improving the quality of self-medication behaviour is warranted. Urgent measures are needed to address the issue of easy access to POMs at community pharmacies, and to improve access to formal medical care among the low-income population.

Factors associated with self-medication in Spain: a cross-sectional study in different age groups

Objective

The identification of factors which may influence a patient’s decision to self-medicate.

Methods

Descriptive, cross-sectional study of the adult population (at least 16 years old), using data from the 2009 European Health Interview Survey in Spain, which included 22 188 subjects. Logistic regression models enabled us to estimate the effect of each analysed variable on self-medication.

Key findings

In total, 14 863 (67%) individuals reported using medication (prescribed and non-prescribed) and 3274 (22.0%) of them self-medicated. Using logistic regression and stratifying by age, four different models have been constructed. Our results include different variables in each of the models to explain self-medication, but the one that appears on all four models is education level. Age is the other important factor which influences self-medication. Self-medication is strongly associated with factors related to socio-demographic, such as sex, educational level or age, as well as several health factors such as long-standing illness or physical activity.

Conclusions

When our data are compared to those from previous Spanish surveys carried out in 2003 and 2006, we can conclude that self-medication is increasing in Spain.

Self-medication and its risk factors among women before and during pregnancy

Introduction

Self-medication can cause significant challenges for the individuals and community, especially in women during pregnancy. This study was aimed to compare the prevalence of self-medication before and during pregnancy among women in Iran.

Methods

in this cross-sectional study, a total of 384 pregnant women were evaluated for the prevalence of self-medication and its associated factors before and during pregnancy. Stratified random sampling was used as the sampling method. Descriptive statistics and chi-square and logistic regression tests were used for statistical analysis of data.

Results

The results showed that the prevalence of self-medication, in women who had become ill at least once, was 63.9% before pregnancy and 43.5% and during pregnancy. Variables such as lack of insurance, high school education and not having a child increased odds ratio of self-medication before pregnancy, while the variables of lack of insurance, not having a child or fewer number of children and no history of abortion increased the odds ratio of self-medication during pregnancy.

Conclusion

Although the prevalence of self-medication during pregnancy was less than that before pregnancy, but this prevalence during pregnancy was still significant. Therefore, it seems necessary to provide public trainings for all women of reproductive age and train them about the dangers and side effects of self-medication.

Self-Medication Pattern among Social Science University Students in Northwest Ethiopia

Background. Inappropriate self-medication causes wastage of resources among others. Method. This survey study was conducted to determine self-medication pattern of 404 social science university students in Northwest Ethiopia, who were selected through stratified random sampling technique. Data were collected using self-administered questionnaire and analyzed with SPSS version 20 statistical software. Binary Logistic Regression analysis was employed with P value < 0.05 considered statistically significant. Result. At 95.3% response rate, mean age of 21.26 ± 1.76 years, and male/female ratio of 1.26, the prevalence of self-medication during the six month recall period was 32.7%. Headache (N = 87, 69.1%) was the primary complaint that prompted the practice and hence analgesics (N = 67, 53.2%) were the mostly used drugs followed by antimicrobials (N = 50, 39.7%). The top two reasons driving the practice were nonseverity of the illness (N = 41, 32.5%) and suggestions from friends (N = 33, 26.2%). Female sex (P = 0.042) and higher income (P = 0.044) were associated with the practice. Conclusion. Self-medication practice, involving the use of both nonprescription and prescription drugs such as antimicrobials, among the social science university students is high. Therefore health education interventions regarding the risks of inappropriate self-medication are essential.

Self-care use patterns in the UK, US, Australia, and Japan: a multinational web-based survey

BACKGROUND

The trend toward patient- or consumer-centered healthcare has been accelerated by advances in technology, consumer empowerment, and a shift from infectious to chronic diseases. The purpose of this study was to examine the growing self-care market by analyzing self-care patterns.

METHODS

We conducted a cross-sectional, web-based survey involving adults from nine major cities in the UK, the USA, Australia, and Japan. This study examined the extent and frequency of self-care, self-care expenditure, sources of self-care information, and reasons for self-care in each country.

RESULTS

The results showed that the prevalence of self-care was highest in Japan (54.9%), followed by the UK (43.1%), the USA (42.5%), and Australia (40.4%). The primary reason for practicing self-care was "to manage my healthcare myself" (cited by 45.7%, 59.5%, 49.2%, and 4.1% of participants in Australia, Japan, the UK, and the USA, respectively). Significant linear associations were observed between age and the prevalence of self-care in all countries (p < 0.05), indicating that self-care prevalence decreased with age in the UK, the USA, and Australia, and increased with age in Japan. The frequency with which self-care was practiced was positively correlated with age in the USA (p < 0.05), Australia (p < 0.01), and Japan (p < 0.05). In addition to acquaintances, internet search engines and information obtained from pharmacies were considered reliable and widely used sources of self-care information.

CONCLUSION

When developing self-care products or services, healthcare providers and policymakers should consider self-care patterns.

Use of Traditional and Complementary Medicine as Self-Care Strategies in Community Health Centers: Cross-Sectional Study in Urban Pearl River Delta Region of China

In China, Community Health Centers (CHCs) are major providers of primary care services, but their potential in empowering patients' self-management capacity has not been assessed. This study aims to describe self-care practice patterns amongst CHC attendees in urban China.In this cross-sectional quantitative study, 3360 CHC patients from 6 cities within the Pearl Delta Region were sampled using multistage cluster sampling.Thirty-seven per cent had used with over-the-counter Chinese herbal medicines (OTC CHMs) in the past year and majority of respondents found OTC CHMs effective. OTC CHMs were more popular amongst those who needed to pay out of pocket for CHC services. Less than 10% used vitamins and minerals, and those with a lower socioeconomic background have a higher propensity to consume. Although doubts on their usefulness are expressed, their use by the vulnerable population may reflect barriers to access to conventional health care, cultural affinity, or a defense against negative consequences of illnesses. About 25% performed physical exercise, but the prevalence is lower amongst women and older people. Taiji seems to be an alternative for these populations with promising effectiveness, but overall only 6% of CHC attendees participated.These results suggest that CHCs should start initiatives in fostering appropriate use of OTC CHM, vitamins, and minerals. Engaging community pharmacists in guiding safe and effective use of OTC CHM amongst the uninsured is essential given their low accessibility to CHC services. Prescription of Taiji instead of physical exercises to women and older people could be more culturally appropriate, and the possibility of including this as part of the CHC services worth further exploration.

Observations on the Prevalence, Characteristics, and Effects of Self-Treatment

Aims

When facing illness, a person may choose self-treatment as an alternative to hospital (and primary care)-based treatment. Despite its important role in health care, the study on self-treatment remains limited. The goal is to collectively report the observations in the literature on the prevalence, characteristics, and effects of self-treatment.

Methods

Databases (Medline/PubMed and Google Scholar) were searched. Articles were scrutinized for country of origin, sample size, recall period, prevalence, associated factors, etc.

Results

Published studies have reported that in some regions, the prevalence of self-treatment is high and varies across illness conditions and treatment approaches. Self-medication is the most popular self-treatment approach. Multiple regional, demographic, personal, cultural, and religious factors have been implicated in the pursuit of self-treatment. In addition, accessibility of health care also plays a role. In general, self-treatment has a positive clinical and financial effect. However, there have been concerns on abuse and possible negative effects.

Conclusion

This article reviews observations made in recent studies on several important aspects of self-treatment. Comprehensive and systematic study is still lacking. Interventions are needed to solve several problems associated with self-treatment.

Popularity and customer preferences for over-the-counter Chinese medicines perceived by community pharmacists in Shanghai and Guangzhou: a questionnaire survey study

BACKGROUND

This study interviewed community pharmacists in Shanghai and Guangzhou for their perception of the popular categories of over-the-counter (OTC) Chinese medicines and the factors affecting customer preferences for OTC Chinese medicines.

METHODS

A cross-sectional survey was carried out in six main administrative districts in Guangzhou and eight main administrative districts in Shanghai, China. Descriptive statistical analysis was conducted in this study.

RESULTS

OTC Chinese medicines contributed 21-50% among all the pharmaceutical sales by the community pharmacies. The prevalent categories of OTC Chinese medicines were common cold medicines, respiratory system medicines, digestive system agents, gynecological medicines, health tonic medicines, and qing re (heat-clearing) and qu du (detoxifying) medicines. Customers were more concerned about medical factors of OTC Chinese medicines than business factors. Among the medical factors, the most important was drug safety, followed by efficacy, contraindications, indications, and side effects. Among the business factors, the most important were brand and price.

CONCLUSIONS

This study identified the top sales categories of OTC Chinese medicines in Shanghai and Guangzhou and the important factors such as drug safety, efficacy, period of validity, contraindications, and indications that are affecting the customer preferences for OTC Chinese medicines.

Prevalence of self-medication practices and its associated factors in Urban Puducherry, India

Background and Objectives:

Self medication is an important concern for health authorities at global level. This study was aimed to find the prevalence of self medication for allopathic drugs and associated factors among households of urban community. This study was also aimed at assessing the attitude of respondents who had experienced self-medication.

Materials and Methods:

This cross-sectional study was done in field practice area attached to a medical institution in urban Puducherry. A total of 352 subjects from 124 households were selected by random sampling. With pretested interview schedule, information regarding self-medication use in the past three months and associated sociodemographic factors, purpose, source of drug procurement, attitude toward self-medication use were collected.

Results:

Prevalence of self-medication was found to be 11.9%. Males, age >40 years and involving in moderate level activity of occupation, were found to be significantly associated with higher self-medication usage (P < 0.05). Fever (31%), headache (19%), and abdominal pain (16.7%) are most common illnesses where self-medication is being used. Telling the symptoms to pharmacist (38.1%) was the commonest method adopted to procure drugs by the users. Majority of the self-medication users expressed that self-medication is harmless (66.6%) and they are going to use (90%) and advice others also (73.8%) to use self-medication drugs.

Conclusion:

Self-medication is an important health issue in this area. Health education of the public and regulation of pharmacies may help in limiting the self-medication practices.

Community pharmacy practice in China: past, present and future

BACKGROUND

In 2009, China launched a new healthcare system, with reform of the primary healthcare system as its foundation and focus, to enable residents to access primary healthcare for simple health problems instead of seeking help at hospitals. Community pharmacies and pharmacists were to have increased responsibility in primary healthcare by delivering pharmaceutical care services in China in addition to their traditional roles of dispensing prescriptions and selling medicines.

AIM OF THE REVIEW

To describe the current status of Chinese community pharmacy education and practice, and discuss future directions.

METHOD

A literature search was conducted using MEDLINE and International Pharmaceutical Abstracts. Additional articles were identified through the cross-referencing of articles and books. Additional data were found from relevant websites.

RESULTS

From the 313 publications identified, 98 were included. China currently has 388,000 retail pharmacies, corresponding to one pharmacy per 3,532 population. All pharmacies provide prescription and over-the-counter products, as well as prescription dispensing and patient counselling. However, the lack of reimbursement mechanisms reduces the willingness of pharmacists to offer high-quality dispensing and counselling services. There is a shortage of qualified pharmacists to meet increasing patient needs. This, coupled with a shortage of pharmacist training, has resulted in pharmaceutical care being a low priority for delivery in routine pharmacy practice. To meet the increasing demand for pharmacists, 25 universities have been allowed to offer BS, MS and PhD degrees (3-7 years in length) in clinical pharmacy since 2008. The adoption of Good Pharmacy Practice as a recommended standard for community pharmacy practice provides pharmacists with a framework to aid them in service delivery.

CONCLUSION

A number of undertakings still require development, including the enactment of the Chinese Pharmacist Law, development of a standard for pharmaceutical care activities, development of the pharmacy workforce, increasing public awareness of pharmacists, and proper reimbursement for care provision. Although pharmaceutical care services are underdeveloped in China, they will become an integral part of the professional work of all pharmacists in the future, particularly in community pharmacy settings.